Provider Demographics
NPI:1316082084
Name:BUTLER, THOMAS M (LPCC, IMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LPCC, IMFT
Other - Prefix:MR
Other - First Name:TOM
Other - Middle Name:M
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC-S, IMFT
Mailing Address - Street 1:5352 SANDPIPER DR
Mailing Address - Street 2:
Mailing Address - City:ORIENT
Mailing Address - State:OH
Mailing Address - Zip Code:43146-9228
Mailing Address - Country:US
Mailing Address - Phone:614-875-2551
Mailing Address - Fax:614-875-8995
Practice Address - Street 1:4770 HOOVER RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8504
Practice Address - Country:US
Practice Address - Phone:614-875-2551
Practice Address - Fax:614-875-8995
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2170101YP2500X
OHF032101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1982834974OtherSPIRIT OF PEACE CLINICAL COUNSELING